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Major Depressive Disorder. Mood Disorders. Extremely disabling, second only to heart disease Associated with Suicide; 15% w/ MDD complete suicide MDD most serous and widely studied depressive disorder Individuals must have anhedonia or depressed mood for at least two weeks period of time.

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Presentation Transcript
mood disorders
Mood Disorders
  • Extremely disabling, second only to heart disease
  • Associated with Suicide; 15% w/ MDD complete suicide
  • MDD most serous and widely studied depressive disorder
  • Individuals must have anhedonia or depressed mood for at least two weeks period of time
epidemiology
Epidemiology
  • Lifetime prevalence for any mood disorder is 20.8%
  • Lifetime prevalence for MDD is 16.6% (Kessler et al., 1994)
  • Dysthymia is less common (2.5%-6%)
depression and etiology
Depression and etiology
  • 20 year old female college student presenting to the clinic. She was just released from an inpatient facility for attempting suicide. This has not been her first attempt. In addition to her frank suicide attempts she has engaged in a number of nonlethal self harm behaviors. She presents with major depression, severe and has nearly all of the melancholic features. Her speech is labored, her affect is blunted, her movements appear slow. Prior to her diagnosis of mdd she had a diagnosis of dysthymia.
signs and symptoms of mdd
Signs and Symptoms of MDD
  • Vegetative: loss of satisfaction, loss of interest in sex, early morning awakening, loss of appetite, loss of weight, social withdrawal
  • Cognitive Signs: Difficulty concentrating, indecisiveness, low self esteem, negative thoughts about the self, world and others, guilt, suicidal ideation and in more severe cases psychosis
signs and symptoms of mdd6
Signs and Symptoms of MDD
  • Mood signs: feeling sad, empty, worried, hopeless and irritable
dysthymia
Dysthymia
  • Chronic low level depression lasting 2 years or more
  • Symptoms can not be absent more than 2 months at a time
  • Can not have MDD within the first 2 years of the disorder
etiology
Etiology
  • Twin Studies and Family studies

Heritability and specific environmental factors such as stress affecting one twin but not the other appear to be important.

--Correlation between MZ twins is .46, compared with DZ twins is .20.

Genetic propensity exists but learning and environmental factors play an important role

medical illness
Medical Illness
  • Endocrinological Disorders
  • Stroke
  • Parkinson’s Disease
  • Pancreatic Cancer
  • Coronary Heart Disease
  • Myocardial Infaction
  • Cerebrovascualr disease
neuropsychology and psychopharmacology
Neuropsychology and Psychopharmacology
  • MRI studies revealed MDD have evidence structural differences compared with controls:
    • ventricular enlargements and sulcal space compared with control patients. Areas of impact include the frontal lobes, subcortical white matter and caudate nuclei
neurotransmitters hormones and depression
Neurotransmitters, Hormones and Depression
  • Monoamines
  • Norepinephrine
  • Serotonin
  • Dopamine
  • Cortisol
personality
Personality
  • Prospective Studies and Temperament
  • Neuroticism
stressors
Stressors
  • Prolonged exposure to psychosocial stress
  • Most episodes are preceded by a severe life event or difficulty in the 6 months before the onset of the episode;
  • Increased rates of childhood abuse
  • Themes of loss
  • Maternal loss
diathesis personality stress unipolar depression
Diathesis/Personality/Stress: Unipolar Depression
  • Diathesis
  • Females more at risk than males
  • Family history of unipolar depression
  • Monoamine Deficits
  • Diminished Norepinephrine
  • Diminished Serotonin
  • Diminished Dopamine
  • Personality
  • Neuroticism
  • Behavioral Inhibition
  • Anxiety
  • Social reticence
  • Fearful in presence of strangers
  • Lower sensation seeking

Stressor

Interpersonal Loss

Threats to economic security

Cummulative Negative Events

Traumatic Events (defined by Criterion A)

heterogeneity of depression
Heterogeneity of Depression
  • Haslam and Beck
    • Examined empirical research for evidence of distinct subtypes of depression
    • Subtypes
      • Endogenous
      • Sociotropic
      • Autonomous
      • Self-critical
      • Hopelessness
criteria for analysis
Criteria for Analysis
  • Indicators must be dichotomous
  • Items were standardized
  • Was it a taxon?
    • Do the symptoms hang together?
    • Which elements appear important
    • Were they discrete or continuous?
findings
Findings
  • Discrete subtype for endogenous depression
heterogeneity of depression male presentations
Heterogeneity of Depression: Male Presentations
  • http://www.nimh.nih.gov/health/publications/real-men-real-depression.shtml
  • http://www.nimh.nih.gov/health/topics/depression/men-and-depression/

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the masculine depression scale
The Masculine Depression Scale
  • Depression is twice as common in women as in men;
  • Perhaps men evidence depression symptomatology that is differerent from that of women and that these differences lead to disparate prevalence rates;
the masculine depression scale20
The Masculine Depression Scale
  • Developed a self-report instrument designed to assess ‘masculine depression’
  • Examined the correlation between men who adhere to masculinity hegemonic norms and masculine depression
sample items
Sample items
  • Anger, aggression, irritability
  • Substance abuse
  • Withdrawal from family/social interactions
  • Overfocus on work/school
  • Inability or unwillingness to display soft emotions
  • Self-criticism of self/sense of failure
findings22
Findings
  • Men who adhered to masculine norms were more likely to endorse externalizing symptoms of depression than prototypic symptoms of depression
    • I’ve yelled at peoplor or things
    • I’ve had a short fuse
    • I got so angry I smashed or punched something
    • I don’t get sad I get mad
    • I’ve been drinking a lot
    • I’ve been under constant pressure
    • I’ve needed to handle my problems on my own